surgical conditions

Question 1

what scales can be used to assess severity of pain?

Answer 1

visual analogue scale 0-10

wong baker pain faces scale

Question 2

according to WHO analgesic ladder, what should be used for step 1?

Answer 2

non opioid

with or without adjuvant analgesic

Question 3

what should be used for step 2?

Answer 3

opiod for mild to moderate pain
plus non opioid
with or without adjuvant analgesic

Question 4

what should be used for step 3?

Answer 4

opiod for moderate to severe pain
plus non opioid
with or without adjuvant analgesic

Question 5

what is a simple analgesic?

Answer 5

paracetamol

Question 6

examples of NSAIDs

Answer 6

aspirin
ibuprofen
diclofenic
naproxen

Question 7

examples of weak opiates

Answer 7

codeine
dihydrocodeine
co- codomol

Question 8

example of a moderate opiate?

Answer 8

tramadol

Question 9

examples of strong opiates?

Answer 9

morphine
oxycodone
pethidine

Question 10

when is diclofenac contra indicated?

Answer 10

in cardiovasculer disease

Question 11

when is pethidine not recommended?

Answer 11

post operatively

as it is metabolised in the renal system

Question 12

what may opiates cause?

Answer 12

respiratory depression

Question 13

When should caution be taken with NSAIDS?

Answer 13

hepatic impairment
renal impairment
pregnancy- generally avoided
GI pathology
asthma
cardiovascular events

Question 14

how can opiate toxicity present?

Answer 14

reduced consciousness
pin point pupils
hypotensive
cyanosis
muscle spasm
seizure

Question 15

how should opiate toxicity be managed?

Answer 15

ABCDE

naloxone

Question 16

What is naloxone?

Answer 16

opiod antagonist

Question 17

how does naloxone work?

Answer 17

reverses CNS depression, respiratory depression and hypotension

Question 18

What dosage should naloxone be given in?

Answer 18

0.4- 2 mg IV

intervals of 2-3 minutes

Question 19

what is the maximum dosage of naloxone?

Answer 19

10mg

Question 20

what are possible investigations re. constipation?

Answer 20

exam
rectal examination
abdominal xray
barium study
colonoscopy

Question 21

when is a reactionary haemorrhage most common?

Answer 21

4-6 hours post op

Question 22

when does a secondary haemorrhage occur?

Answer 22

7-14 days post op

Question 23

what can secondary haemorrhage be caused by?

Answer 23

due to infection or eroded vessel

Question 24

What can cause post operative hypotension?

Answer 24

bleeding
dehydration
sepsis
opiate overload
spinal anaesthesia
refractory anaesthesia

Question 25

what indicates pyrexia in the surgical patient?

Answer 25

a temperature over 37.5 degrees

Question 26

What are the sepsis 6?

Answer 26

``` deliver high flow oxygen administer IV antbiotics administer IV fluids take bloods take swabs measure urine ```

Question 27

what measures should be taken if patient pyrexic post operatively?

Answer 27

``` check obs check IV access lines, catheter, wounds take blood cultures test urine- dipstick and c+s swabs ECG or ECHO if indicated ```

Question 28

what are possible causes of post operative pyrexia?

Answer 28

``` day 1-2: acetlectasis day 3-4: pneumonia day 5-6: anastomtic leak day 7-8: wound infection day 9+ : DVT or PE ```

Question 29

what is ACS?

Answer 29

acute confusional state

Question 30

who is ACS common in post operatively?

Answer 30

``` elderly those with exsiting cognitive impairment psychiatric morbidity sensory impairment dehydrated, malnourished drug or alcohol depandance ```

Question 31

what is hypochloremic alkalosis?

Answer 31

low chloride and high bicarbonate

Question 32

what is hypokalaemia?

Answer 32

low potassium

Question 33

what can hypokalaemia cause?

Answer 33

cardiac arythmia

Question 34

what is a mallory- weiss tear?

Answer 34

tear in junction of stomach and oseophagus

Question 35

how does mallory weiss tear present?

Answer 35

repeat or profuse vomitting